April 02, 2020

COVID-19: What You Need to Know

This popular Podcast episode received an industry award for production.

Baptist Health Floyd’s Chief Medical Officer, Jayakrishnakamal “Krishna” Konijeti, MD, issued a public service announcement this week. His message was clear: Stay home, southern Indiana.

Speaking by phone for this podcast, Dr. Konijeti expands upon this plea to those in the community where he lives and practices medicine. He explains what it means to “stay at home” and how doing so can help his hospital and others control the anticipated peak of COVID-19 cases. He speaks frankly about the pandemic, including current case numbers, the need for widespread testing, and the steps Baptist Health has taken to prepare and protect both patients and staff.

Listen now to learn what you need to know to keep your family safe.

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Episode 3: Transcript

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Kerri: Hey guys, I’ve got a special episode of the HealthTalks NOW podcast. I know you’re cooped up at home right now, and it hasn’t been easy. We’re certainly in this together, but we’ll get through this together. I turn today to a unique guest for a timely conversation, Chief Medical Officer, Baptist Health Floyd. I think you’ll enjoy this one

Kerri: Baptist Health Floyd released your public service announcement yesterday, and the audience reach was wide. The message was clear. And we’re talking today, on March 31st, over the phone to learn more. Dr. Krishna Konijeti, thank you for making time to speak with me today.

Dr. Konijeti: No problem.

Kerri: You’ve issued a warning to Floyd County residents, in a PSA that caught readers’ attention, saying that the county has become a COVID-19 hotspot. Why?

Dr. Konijeti: The main reason is we were one of the first counties to start really testing. We’ve been much more advanced in our relationships with different labs including the U of L Research lab that does testing, so I think we picked up more, and when you look at our rate of incidence, even based on the public service announcement I gave yesterday when you say that there are over 50 positives and a little over 200 positive tests that came back, that’s almost a 20 to 25% incidence of positives. That’s a high rate of positives, and when you look at the statewide distribution and map, pretty much, we’re the third-highest region outside of Hamilton/Marion County, which is Indianapolis, and then Lake County, which is outside of Chicago, so Floyd and Clark County become the next biggest spot, percentage-wise, per capita.

Kerri: Sure. And I saw the update that 96 people alone were tested today.

Dr. Konijeti: Yeah, that’s correct, and that’s been a great feat by Dr. Harris and the Floyd County Health Department. They worked tirelessly to set up the first drive-through testing area in Floyd County, and the drive-through is not drive through in the sense that anyone who wants to can come there and get tested, but it’s drive-through in the sense that you call ahead of time and you have a referral from your primary care physician, or you get screened by the health county official and you get that testing done. So the majority of the tests that we’ve done today, were actually at the Health Department drive-through. The emergency department has actually tested a little less today, which is a good thing.

Kerri: Okay. What’s your projection for these figures? Where are we trending?

Dr. Konijeti: The trend is definitely up every single day. The numbers are increasing, and we’ve had a couple of days where we had exponential increases, so very significant increases, but overall, we haven’t had any days where we’re decreasing overall in total numbers tested, which is good, because we’re screening and testing more people, but obviously, that’s also bad in the sense that also means there are more patients that are meeting the criteria for testing, so that means there’s been more wide exposure.

Kerri: Okay. So given that answer, we have not hit the peak of the surge. What will that look like when we do ?

Dr. Konijeti: No one knows when the peak of the surge is, just like no one knows when the flatten the curve is going to occur, and as I said in my PSA yesterday, I think a lot of us in the health care industry are looking more towards keeping that peak as low as possible for as long as possible as we can, and getting it on the downward slope. When it finally levels off, we don’t know. In our best estimations based on what Dr. Fauci and the NIH, and the CDC have said, and what our state epidemiologists are saying, it’s looking like somewhere around the end of April, beginning of May is where we’re potentially going to hit this peak, and I say this peak, because there’s always the possibility that it goes down for a period of time, and then peaks again.

Dr. Konijeti: That’s the general path of viruses, as we don’t have cure for viruses. So when that peak surge occurs, it’s going to look much worse than it does now. Right now, as we’re talking, at the hospital today, we have 13 positive patients hospitalized, plus 28 other what we call PUIs, or persons under investigation. So that in and of itself is a high number. We’ve already had to open up a second dedicated what we call COVID unit or coronavirus unit, that is handling the patients that are strictly positive or persons under investigation. So when we’re talking the peak or surge being three weeks away, or four weeks away, or five weeks away, that definitely makes me nervous and makes all health care providers nervous.

Kerri: Sure. Looking at the demographics for positive cases, the groups most affected are 50 to 59 years old, followed by 60 to 69, but I found it interesting that 30 to 39-year-olds outnumber the 70 to 79-year-old group. Should we anticipate that the trend for younger people to become more infected, to continue increasing? Is that going to continue to be a problem?

Dr. Konijeti: I think that’s more a function of, and the answer is, first of all, that this virus doesn’t discriminate on age. There’s been international reports of newborn babies having COVID-19, obviously, the majority of people hard hit by the disease are elderly patients in that greater than 60 population. Having said that, there have been very severe cases, deaths in all age groups. So I think the trend we’re seeing, more of that middle-aged group that’s getting tested positive, is just because our screening has increased.

Kerri: Okay. Okay. With each update and streaming news conference, we hear of the changes in recommendations. What should we do when we hear of the increasing numbers, and what should families do who are impacted, when it’s their loved ones that have tested positive?

Dr. Konijeti: So when their loved ones are tested positive, first and foremost, follow the Health Department’s instructions for quarantine, whether it’s, obviously if they’re able to be healthy enough to be quarantined at home, then make sure that you’re following the Health Department’s direction on quarantine, and then for them to self-monitor, again under the direction, as family members in this context, of the positive person for them to be self-monitoring at home and taking the proper precautions as recommended by the Health Department, so they can be screened potentially if they need to, if they start developing symptoms, so they can get screened. But again, it’s hard to say, because the virus can often lay asymptomatic for days while you’re positive. So if you’re a family member of a known contact, the recommendations are getting stronger every data to self-quarantine, so.

Kerri: Okay. Is there anything that we can do as the public to show them support?

Dr. Konijeti : Living up to your social responsibility, living up to your civic responsibility, making sure that you’re helping people that can’t help themselves. If there’s friends or family members, elders, people that are more hardly affected, making sure that you’re offering to help them, whether it’s making that grocery trip for them so they don’t have to get out, and so you can get yours, and a family or a friend’s groceries or something done all at once to do that. Obviously, our community as a whole needs to get together to support everyone. I mean, undoubtedly, this has affected all of us in different ways to different levels, but it’s affecting us economically, socially, and health-wise. So just recognizing that everyone’s going through this, and obviously, it’s human nature to wait until it hits home, or someone you know or love has been affected. I hope that as a community that we can see and just do the right thing to embrace helping other people, while also maintaining the orders given by the federal, state, and local government. So just-

Kerri: Certainly. I’ve seen an increase of blood drives, as well as charities and the hospital foundations as well.

Dr. Konijeti: So one of the big issues is with all of this, just like personal protective equipment, other medicines, other resources, we are short on things like blood because people, rightfully so, aren’t going out for unnecessary trips. But if there’s a dedicated blood drive, and that’s controlled by The Red Cross, by the Health Department, those are things that all the proper precautions are being taken to decrease and minimize impact, and definitely encourage people to still do those things so we can help our community. For example, in Floyd County, also going back to what you said about the foundation, our foundation has set up a COVID specific charity pod that they’re using to help providers, help nursing staff, help ancillary staff get the things that they need, and to help the community with the things that they need, with those dedicated funds. A lot of times, we have to work within certain confines as a hospital institutions or system, in order to procure certain items like personal protective equipment, and the foundation can sometimes go a little bit outside of that box to help us. So there’s a lot of things like that that can be done.

Dr. Konijeti: The other thing I would say, from a community standpoint is, is remember, there’s different ways that people are affected, not always just from the health care standpoint, but from the community standpoint. I always like to use the example of my wife is an old hospital administrator, and now she’s finishing up her graduate social degree, and she works at the new Albany County schools for her practicum, and she tells me every day that she’s been worried sick because of the schools closing, that the kids that came to school and were getting their primary meal at the school aren’t getting that, those resources, and those abilities. So it’s important for us as a community to remember all those things too, and to do what we can to support everything, and not just our health care facilities, but everything.

Kerri: Sure, it is a big picture. As the chief medical officer of Baptist Health Floyd, you’re also a practicing nephrologist in the region, and as I understand, you’re a resident in New Albany. You pointed out something yesterday in the PSA, the community hasn’t fully embraced the warnings by Governor Holcomb, his stay at home order that was issued six days ago. How does that impact community transmission?

Dr. Konijeti: So the definition of community transmission is when a disease is transmitted without a clear cut cause, and the way this virus is stealthy, like I said earlier, is that patients or people are asymptomatic for days, before needing to go get tested. So during that time, they can transmit, so that’s how community transmission is worse. So if you’re out and about, you can be healthy, you can still pick it up, you can still transmit it before you even have signs, and that was the biggest reason why I put out that PSA after talking to Dr. Harris, the County Health Department director, is because of that, is because if everyone’s just out and about in business as usual and not taking heed to it, this is going to get even more exponentially worse than it has to. So we all have the ability to help that apex from getting too high, so.

Dr. Konijeti: Yeah. Leading into the next question I was going to ask you, I’d love for you to elaborate a bit more, is, people are still going out and about, and if they’re honoring the six feet social distancing rule, can you make that clear distinction why it’s so much more important and critical to remain at home? As you said yesterday in the announcement, to shelter at home and in place.

Dr. Konijeti : So again, the mandate from the governor’s mandate, and I’m not a lawyer or politician by any means, no one knows what the enforceability of any of that is, but it’s all based on scientific research and protocols, and guidance from our CDC and National Institute of Health. Initially, it was thought that we could flatten that curve, decreasing the incidence of the disease by trying social distancing of six feet, because generally speaking, the virus, for the most part, is not airborne. It’s spread through droplets, whether it’s coughs, sneezes, respiratory droplets. Now, it can be transmitted off of certain surfaces and things like that, but the whole idea behind social distancing initially was that you’re going to decrease that risk. So that was the initial step, okay?

Kerri: Okay.

Dr. Konijeti: But social distancing as a whole across the world, hasn’t really panned out. The shelter home and in place is that next step. It’s about not only staying away from people six feet when you do have to go out and do those essential things, like going to the grocery store, or picking up your drugs, or going to a doctor’s office, but it’s also about basically, if you’re not living with a person, you shouldn’t really even be around them, because that’s the real way that you’re going to decrease the transmission of the disease. Unfortunately, we can’t, I shouldn’t say unfortunately, I don’t want people to get it wrong, but I mean, we’re not a communist country like China where everyone’s forced to stay at home, and they have drones flying around the city of Wuhan and Hubei province to make sure everyone’s home, so we have to rely on our society doing the right thing and trying to stay home.

Kerri: Got it. Well, so if someone believes that they are experiencing symptoms, what should they do and where should they turn?

Dr. Konijeti: So obviously, there’s a whole basket of symptoms that have been identified. Obviously, the predominant symptom is fever, and then second-most, cough, and then shortness of breath and congestion, sneezing, labored breathing, feeling like you can take a good deep breath, and even more recently, it’s been shown that if you lose your sense of smell, that may be a sign of a COVID-19. So all these things, if you’re feeling symptomatic, one, obviously you should check your temperature, you should self-quarantine, call your primary care doctor, run everything by them so they can screen you with the appropriate questions, make sure there’s not something else going on that could explain a fever, for example, a urinary tract infection, or a wound, or something else like that, but obviously, if you’re having respiratory symptoms, they’ll screen you and then they’ll make the referral to the Health Department.

Dr. Konijeti: If you don’t have a primary care physician, you can still call the Health Department, and they’ll screen you and determine whether or not you need to get tested. The reason to go to the emergency department, or not go to the emergency department and self-quarantine at home is all dependent on the clinical symptoms. So if you have mild symptoms and you’re otherwise healthy, you can follow your primary care doctor’s guidance and just self-quarantine at home, and potentially not get tested. There’s other options where they may refer you to our testing site, the Baptist Health Urgent Care Center at Highlander Point. They may send you up there, they may send you to the Floyd County Health Department, or if your symptoms are severe enough, then you obviously need to come into the emergency department and get checked out.

Kerri: Okay. We also have an assessment tool on the website and I know that the team has also been busy with eVisits and virtual care video visits as well to communicate, but if someone believes they do need to come to the hospital and they’re wary about coming to the hospital right now for care, what would you say to that person, and are there services still being offered at Baptist Health Floyd?

Dr. Konijeti: Yes, there are still services being offered at the hospital. If you’re concerned that you’re ill and sick, you need to come to the hospital after talking to your primary care physician, and you need to get evaluated and treated. As far as services at the hospital, we’ve, in the idea that we need to preserve personal protective equipment and resources for this search, whenever it happens, we have already proactively discontinued all non-emergent procedures and testing. Having said that, we’ve set up alternatives for a lot of noninvasive testing and procedures, such as, for example, a patient that’s going to see a cardiologist needed to get a stress test or needed to get an echocardiogram, even though we’re not doing those at the hospital right now, there’s other sites where those kinds of tests are available. We’re still doing outpatient labs, we’re still doing other noninvasive tests at different locations. We’re trying to minimize the traffic at the hospital with the intention of minimizing exposure to the community and to our staff, and preserving our resources, but if you need to come to the hospital, that’s what we’re here for.

Kerri: Sure. Well, speaking of PPE, is Baptist Health Floyd prepared? Do you have enough PPE?

Dr. Konijeti: Yes, we do have enough PPE, as of right now. PPE is always a concern, and it’s a moving target depending on day-to-day, depending on the number of patients we have that are under investigation or are positive, and the number of people caring for them that have to wear PPE going in, and the one thing that we have is the help of the system. We have a kind of a system with our sister hospitals in Louisville, La Grange, Lexington. We have a system number that we keep. That’s how we know really what we have. So a lot of media outlets, a lot of people ask, “Well, how many days on hand of something do you have?” Well, we can’t really say that, because everything’s allocated by the system, but even locally, we have enough, and the public has been great. We’ve had dentist’s offices, we’ve had [inaudible 00:20:41], we’ve had multiple different people, construction companies that have, even Target, have dropped off any masks that they’ve had, both N95s and non-N95s, so all of our donations for personal protective equipment are going through the Floyd foundation.

Dr. Konijeti: So definitely, we’re still interested in receiving actual masks. We will not, as of right now, based on CDC guidelines, we’re not taking any homemade masks at the present time, for multiple reasons, but I would suggest to provide anyone that wants to do those kind of masks, provide those to some long-term care facilities around the areas, other entities that could use that, maybe even like Kroger, where the people that work there are getting exposed, them having a homemade mask is better than nothing. But so, and again, we have the fund through the foundation that the public can donate to.

Kerri: Great. Yeah, the support has been amazing. I’ve seen across the system, even tattoo parlors and nail salons donating masks, in addition to the businesses that you’d mentioned.

Dr. Konijeti: Yeah, it’s been wonderful.

Kerri: I want to ask you about providers. If a staff member tests positive, will they receive support?

Dr. Konijeti: They do. They receive support, one, locally at the institution. Obviously, we care about our providers, our nursing staff, and our ancillary staff. I mean, that’s our bread and butter, that we can’t be good or help anyone if we’re not healthy and taking care of ourselves. So at Floyd, we definitely understand that our staff is the most important asset, and that’s why starting yesterday, we started masking everyone in the hospital that works in the hospital, whether they be environmental services, or a nurse, even in low risk areas, just to decrease that risk of community transmission, or transmission for them or to a patient. So if a provider is positive, and luckily, we haven’t had the kind of positives in our providers and our staff as some of the other institutions in the greater Louisville area have, we have the Employee Health and the Health Department, and our infection control and infection prevention team here at the hospital can help in getting that patient’s needs taken care of.

Kerri: Great. So there something I’ve been wanting to ask you. We’ve been reading about the possibility of being asymptomatic with this disease. If that person is tested later, can antibodies be tested and detected, and along that line can someone be tested twice?

Dr. Konijeti: So there are a lot of patients that are asymptomatic and that never do become symptomatic. Theoretically, based on virology and immunology, yes, that person could have antibodies detected. As of right now, the majority of the tests that are used to detect the presence of the virus are PCR-based, or polymerase chain reaction-based, where they test for fragments of the virus RNA. The antibody tests are still under development, for the most part. There are a few that are coming out, and hopefully out soon. So theoretically, yes, in practicality, right now, no.

Dr. Konijeti: And can someone be tested twice? There has to be a pressing need and indication to get tested twice, because of the methodology of our testing, which is that as I said, is that polymerase chain reaction of three different mRNA spots on the virus. The likelihood that you have a false negative is extremely low, and coupled with the overall national scarcity of tests and test kits, that makes it very unlikely that a person can be tested twice. Having said that, if there’s enough clinical indication and we have a triage committee with our infectious disease doctor, or pulmonary doctor, and myself, we can look at a case and if there’s worry that maybe the specimen wasn’t collected properly, maybe the swab wasn’t done properly, and maybe the patient has really pressing symptoms that are indicating this, we’ve made a couple of exceptions to get a patient tested twice.

Kerri: Okay. I’d like to get your opinion on this. Should people be masking when they go in public for essential items, if they’re running to the grocery store?

Dr. Konijeti: In my opinion, yes. If they’re otherwise unhealthy, immunocompromised, again, the big play in this is that they should be trying to stay at home as much as possible and only doing the essential things. The problem with wearing a mask and doing it for prolonged periods of time, is the integrity of the mask and whether or not it’s soiled, and whether or not the mask has been contaminated, and whether or not you’re just using a dirty mask, and that makes you even more likely to get the virus. So the answer is yes, if used properly and for the right patient population, yes.

Dr. Konijeti: In my opinion, yes. If they’re otherwise unhealthy, immunocompromised, again, the big play in this is that they should be trying to stay at home as much as possible and only doing the essential things. The problem with wearing a mask and doing it for prolonged periods of time, is the integrity of the mask and whether or not it’s soiled, and whether or not the mask has been contaminated, and whether or not you’re just using a dirty mask, and that makes you even more likely to get the virus. So the answer is yes, if used properly and for the right patient population, yes.

Dr. Konijeti: Okay. Well, anything else you want to share with the audience today?

Dr. Konijeti: I just want everyone to know that here at Floyd, we’re there for them, if and when they need us, and I can’t express enough how awesome our team has been and risen to the occasion in terms of everyone looking out for each other in the community, and doing what they need to, to get everything implemented as quickly as possible, and doing it ahead of the curve, compared to many other places. So I just have to do a shout-out to everyone that works at Baptist Floyd, so.

Kerri: I really appreciate you jumping on this call with me today.

Dr. Konijeti: No problem. Have a good night.

Kerri: You too, take care.

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